Share This Story!

'Free' visit to doctor may not be so free after all

CINCINNATI — Access to free preventive health care services has been touted as a cornerstone of the nation's health reform law. But certain services that some patients believe qualify as preventive are surprising them with unexpected, costly bills.

But certain services that some patients believe qualify as preventive are surprising them with unexpected, costly bills.

From Medicare patients undergoing colonoscopies to patients scheduling screenings to discuss medical concerns, there is a lot to know about which services are fully covered and which will trigger co-pays and bills.

"I think people hear, 'I can get free care.' But they're really getting free preventive care, not care for their problems," said James Sosnowski, a gynecologist and president of the Academy of Medicine of Greater Cincinnati.

Under the Patient Protection and Affordable Care Act, dozens of services qualify as preventive, including nearly a dozen vaccines for adults and screenings for blood pressure, diabetes and high cholesterol.

"People get confused because they come in for a yearly exam and then they start complaining about X, Y or Z problems that they're having," Sosnowski said. "If a doctor is (billing) correctly, that patient is going to get charged. And people do get angry."

Lawmakers, doctors and patients call for change

The confusion has legislators, doctor's offices and insurers taking action.

Sen. Sherrod Brown, D-Ohio, recently introduced legislation that would make all colorectal cancer screenings cost-free for Medicare beneficiaries — including those visits in which a polyp is removed.

Under current law, seniors covered by Medicare are eligible for free colorectal cancer screenings. However, if a doctor discovers and then removes a polyp while the patient is under anesthesia, the patient is billed as if the procedure was treatment rather than prevention.

“People get confused because they come in for a yearly exam and then they start complaining about X, Y or Z problems that they're having. If a doctor is (billing) correctly, that patient is going to get charged. And people do get angry.”

James Sosnowski, gynecologist and president of the Academy of Medicine of Greater Cincinnati

"Too many seniors who go in expecting a free preventive screening wake up to an unexpected and significant bill," said Brown. "We must do everything we can to make potentially lifesaving procedures as easy and affordable as possible."

"This cost-sharing creates unforeseen financial burdens in those patients that benefit most from screening: those with colon polyps," said Colleen M. Schmitt, president of the society. "The legislation is vital in achieving higher colorectal cancer screening rates and reducing deaths from this largely preventable disease."

Another confusing practice: Medicare promotes preventive care with free annual "wellness" visits, but during the visit patients learn that they can't talk about ongoing health issues or they will be charged. That's leading some patients to forgo scheduling new appointments.

Many patients are confused by the wellness visits, said Dr. Randy Wexler of Ohio State University's Wexner Medical Center.

"We'll often call the patient and explain to them what Medicare considers wellness and what it is not," said Wexler. "For Medicare, it's a visit to make sure your prevention and screening is taken care of. It is not a visit to take care of your diabetes, your high blood pressure and talk about your new back pain."

When patients seek medical consultation for other conditions they're facing, that's when they're likely to get hit with a bill, Wexler said.

Changing health industry adds to the confusion

Part of the change patients are noticing has nothing to do with new rules under Obamacare, said Sosnowski. In recent years, physicians were acquired by health systems that now use electronic medical records. For nearly every medical service offered, there is a correlating insurance code that eventually translates into the price the doctor charges for the care. The high-tech systems allow doctors to charge for a variety of services during an office visit with just a click of a button.

The new landscape is forcing some new — and sometimes difficult — conversations between doctors and patients about the cost of care.

"It can put us in a tough spot," Sosnowski said.

In some cases, Sosnowski says he encourages patients to contact their insurance company first when he thinks services will cost them extra.

Some insurers are already working to educate their policy holders on the finer points of the murky waters. Many insurers websites' offer breakdowns for preventive and non-preventive services.

"People really need to know, from the get-go, what they're signing up for when they buy their plan and what's going to be covered," Sosnowski said.

Contributing: Kaiser Health News.

Will this visit cost me?

The federal health care law requires most insurers and Medicare to cover preventive care at no cost to patients, but the details of what's actually covered can be confusing. Here's a look at some examples:

Preventive (covered)

• All adults: Vaccinations recommended by the Centers for Disease Control and Prevention; screening for high blood pressure, cholesterol, diabetes, depression, HIV, alcohol misuse, obesity, tobacco use and colorectal cancer